Elbow and Forearm
Chapter 18
Half this game is ninety percent mental.
Danny Ozark, Philadelphia Phillies Mgr.
Characteristics of the Elbow
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Most muscles crossing the elbow are twojoint muscles
Angular velocity at the elbow during
pitching is 2300 degrees/second
Biceps and triceps co-contract to provide
weight bearing stability
Elbow instability occurs mainly due to
medial collateral ligament tears (UCL)
Joint Stresses at Elbow
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Acceleration: lateral compressive forces and
medial distraction forces applied to elbow joint
Deceleration: high demands on bicep,
brachioradialis, brachialis
Lateral stresses – osteochondritis dessicans in
young, osteophytes and osteoarthritis in older
adults
Medial stresses – neuritis, tendinitis, medial joint
sprains, muscle strains
Specific Sport Stresses
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Baseball: medial distraction and lateral
compressive stresses; increase in medial
joint stresses with inflexibility of hips, trunk
shoulder or if elbow drops due to tightness,
weakness, fatigue
Tennis: lateral epicondyle stress
(backhand); medial epicondyle stress
(overhead and late-hit forehands); increase
in elbow stress if elbow leads on backhand
Unique Structure of Elbow
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High degree of congruency in ulnohumeral
joint, making it a stable joint
Muscle traverses joint; adhesion problems
can occur with immobilization
Anterior capsule is thin; can be damaged
with aggressive stretching
Joint Mobility
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Loose packed position:
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Ulnohumeral: 70 degrees flexion; 10 degrees
supination
Radiohumeral: full extension with full supination
Radioulnar: 70 degrees flexion; 35 degrees
supination
Concave-Convex Rules for Elbow
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Ulnohumeral: concave ulna, convex
humerus
Radiohumeral: concave radius, convex
humerus
Radioulnar: convex radius, concave ulna
Force Applications
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Lifting weights in elbow extension – more
stress anteriorly
Lifting weights in elbow flexion – more
stress posteriorly
Lever-arm lengths: forces up to 3 times
body weight when elbow flexed 30 degrees
Force Applications: Reducing Stress
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Lighter weights or cuff weights attached to
mid-forearm
Widening hand position in push-ups
Low resistance, high repetitions in early
rehab program
Soft Tissue Mobilization
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Elbow movers: trigger point release, ice
and stretch
Wrist and finger movers: trigger point
release, ice and stretch
Cross friction massage for tendinitis
Joint Mobilization
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Use if greater loss of flexion than extension
Use mild techniques
Use loose packed position
Force applications in same direction as
restricted motion except proximal
radioulnar joint
Caution due to brachialis; contraindicated
with hypermobile joint
Flexibility Exercises
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Preventing loss of motion: CPM, early
mobilization, abbreviated immobilization
Regaining loss of motion: short, active
stretches early; prolonged time later
Prolonged stretches – night splints
Active stretches
Assisted stretches
Aggressive Stretching Precautions
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Brachialis attaches to anterior capsule,
anterior capsule susceptible to injury if
aggressive stretching techniques for
anterior elbow are used
Strengthening Exercises
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Isometrics – held 6 sec, frequently through
day
Isotonics in straight-plane motions
advancing to diagonal-plane motions
Plyometric exercises
Functional exercises before return to sport
participation
Functional Activities
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Warm up and cool down
Begin overhead progressions with easy
activities at diminished distances, forces
and speeds; gradually increase one
component at a time no more often than
every third exercise session
If there is pain, return to previous level of
activity for 3 days
Epicondylitis
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Lateral: tennis elbow
Medial: golfer’s elbow
Correct cause; relieve inflammation and
scar tissue adhesions; improve flexibility,
strength and skill execution
Little League Elbow
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Caused by excessive medial traction forces
at epiphyseal plate during acceleration
Curve and breaking pitches create greatest
forces
Avoid aggressive exercises in rehabilitation
of young people
Sprains
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Hyperextension sprain; anterior capsule
injury; can cause bone bruise in olecranon
region
MCL sprain; injures primary stabilizing unit
of elbow
Cross friction massage to adhesions should
not occur for first 7-10 days after injury
Ulnar Nerve Injury
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Ulnar nerve can become stretched with
medial force
Commonly 4th and 5th digit numbness or
tingling
Rehabilitation of surgical nerve
transposition follows 12-16 week course
Elbow Dislocation
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Most dislocations are posterior with
hyperextension and abduction force
Injury is obvious due to deformity
Splint is worn for 2 weeks with motion
beginning after first week
Rehabilitation may take 16-26 weeks
Arthroscopy
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Usually performed for debridement
Sling is worn 1-3 days
Rehabilitation may take 8 weeks